Thursday, November 25, 2021

Understanding Menstrual Cycle Changes

Below is a guide to perimenopausal bleeding to help you decide when it's time to see a doctor about your symptoms.

Normal can be a little difficult to define when it comes to menstruation. What is considered normal for one woman may not be for someone else. For instance, while the average interval between menstrual cycles is 28 days, a healthy cycle can last between 21 and 35 days.


As you get closer to menopause — which is defined as one year since your last menstruation cycle — you may notice that your normal schedule changes. Women's cycles frequently change in length during the years preceding menopause, which doctors refer to as perimenopause. Bleeding may become more intense or less intense. You may even skip a period on occasion. When these changes are combined with existing individual variation, it can be difficult to determine what constitutes a problem — and what does not.

Dr. Karen Carlson, an internal medicine specialist and associate professor at Harvard Medical School, provided some guidelines for women to use when determining which changes are normal variations and which should be brought to the attention of a physician. Here are her responses.

Q. Could it be common for women to have menstrual changes during perimenopause?

A. Menstrual changes are normal during perimenopause, which typically begins four years before the last menstrual period.

Q. When it comes to the years leading up to menopause, what kinds of changes are typical?

A. As a woman enters her late reproductive years in her forties, her cycles frequently become shorter. The intervals between periods begin to lengthen as perimenopause progresses. Menstrual changes can also be more dramatic, including missed periods and occasional episodes of heavier bleeding. After several years of irregular menstruation, menstrual periods cease entirely. It's critical to remember that no one-size-fits-all pattern exists, and women should never hesitate to report a concern to their physician.

Q. What kinds of bleeding should be brought to the attention of a medical professional?

A. Generally, more severe or prolonged bleeding (greater than seven days) is a cause for concern rather than the absence of bleeding. Between periods, continued irregular bleeding or spotting is not normal and should be reported. Keep in mind that even if you miss a period, pregnancy is still a possibility, even as fertility declines as menopause approaches.

Q. When should you consult with your doctor, and how long should you wait? Is a single abnormal cycle sufficient, or should you wait for several cycles?

A. I will say It depends on the magnitude of the change. Sudden onset of extremely heavy premenopausal bleeding should prompt a call to report the event. It is reasonable for a woman who is experiencing longer cycles or who skips a period to keep a menstrual diary for a few cycles and then consult with her doctor.

Q. What circumstances may result in abnormal bleeding? Is it possible to successfully treat any of these conditions?

A. During perimenopause, abnormal bleeding is frequently caused by the significant hormonal changes that occur during this stage of reproductive life.

Additional common causes of bleeding include uterine problems such as fibroids (benign muscle or fibrous tissue growths that can develop inside or on the uterus), polyps (noncancerous areas of endometrial tissue overgrowth inside the uterus), and adenomyosis (a condition where tissue that normally lines the uterus migrates into the uterine wall). Adenomyosis occurs when the tissue continues to respond to hormones, resulting in menstrual period thickening and bleeding, which can cause discomfort or irregular periods.

Additionally, bleeding can occur as a result of blood clotting problems or as a side effect of certain medications. Less frequently, bleeding may be caused by cervix cancer, precancerous changes (hyperplasia), or uterine lining cancer. Each of these conditions is treatable.

Q. What types of tests should you expect if you have abnormal bleeding?

A. Your doctor may order blood tests, such as a complete blood count, to rule out pregnancy and check for anemia. She may also order a pelvic ultrasound to check for structural abnormalities within the uterus (such as a fibroid or polyp) and to determine the thickness of the uterine lining. Occasionally, a biopsy of the uterine lining is required. Routine blood tests to monitor hormonal levels are frequently ineffective.

Q. Is bleeding a cause for concern if it has been a year since your last menstrual period?

A. Any bleeding following menopause, even a small spot or brownish staining that appears to be old blood, should never be overlooked. Always notify your physician.

Although the majority of cases of postmenopausal bleeding are not caused by cancer, even a single episode can be a symptom of endometrial cancer (uterine lining cancer) and should be thoroughly evaluated.

Source: Harvard Health. Pexel image.


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